Selection tool for Health Extension Workers in rural India

By Sangeetha Lakshmanan, Research Analyst – ICTPH

Several countries have expanded their health systems by adopting the Community Health Worker approach to providing Primary Health Care. While both low and middle income countries have recruited health workers, there is limited documentation on the complete selection process and approach – components central to better health outcomes and sustainability. Due to shortage of health manpower, recruitment, and not selection, has become the concern of program planners. Consequently selection criteria are adjusted with the size of the applicant pool and not with regard to characteristics necessary of applicants3.

Large scale recruitment and training has replaced individual – careful selection leading to either inappropriate selection or attrition at a later stage of the program2. Lack of consistent discussion in existing literature of selection of CHW’s further compromises the generalisability of findings and hinders development of best practices necessary to develop a standardised approach for selection1.

Against this background, “Selection tool for health workers in rural India” attempts to present tools along with an EIGHT STEP process defining a structure for selection of Health Extension Workers. A case study highlighting the implementation of the process along with reflections has been included for review. The paper establishes the need to clearly define the profile while tracing her role within the health system and in the context of providing care at the doorstep of the homes of people. It also recognises that a carefully selected health worker will have great impact not only in retention but also to the sustainability of health interventions and finally the health outcomes of communities.

Download the selection tool here.


1 Brien, M. J. (2009). Role Development of Community Health Workers: An examination of selection and training processes in the intervention literature. American Journal of Preventive Medicine , S 262 – S 269.
2 Gilson, e. a. (1989 ). National Community Health Worker Programs: How can they be strengthened? Journal of Public Health Policy , 10 (4), 518 – 532.
3 Griffiths, & Lirhunde. (1983, 18 (2)). Partnership between people and professionals in selecting community health workers. Community Development Journal , 139 – 145.

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